Hu Chih-Chien, Chen Szu-Yuan, Chen Chun-Chieh, Chang Yu-Han, Ueng Steve Wen-Neng, Shih Hsin-Nung
Department of Joint reconstruction, Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Lin-kou Medical Center, College of Medicine, Chang Gung University, Taoyuan city, Taiwan; College of Medicine, Chang Gung University, Taoyuan city, Taiwan.
J Arthroplasty. 2017 Jun;32(6):1940-1945. doi: 10.1016/j.arth.2016.12.026. Epub 2016 Dec 22.
Total knee arthroplasty in the presence of a huge bone and soft-tissue defect is always a challenge. A rotating-hinged (RH) megaprosthesis is indicated for extensive soft-tissue loss with a huge bone defect such as a primary or metastatic neoplasm of the bone, repeat periprosthetic joint infection, or extensive trauma of the knee. However, the reported survivorship of RH megaprostheses is unsatisfactory. The aim of this study was to evaluate the survivorship of megaprostheses and the factors that contribute to implant survival.
A total of 103 RH knee megaprostheses were implanted in 85 patients between January 2001 and June 2013. Each prosthesis was a modular custom-made (CM) cemented or cementless fixed total knee system (United USTAR system). Clinical results and prosthesis survivorship were evaluated between the 2 groups.
The overall survivorship of this CM knee megaprosthesis was 91% at 2 years, 83% at 5 years, and 68% at 10 years. The cumulative component survivorship was 87% in the cemented group and 96% in the cementless group at 2 years compared with 75% in the cemented group and 94% in the cementless group at 5 years. The failure mechanism included loosening in 5 and breakage in 6 patients in the cemented stem group. The survivorship of the cementless fixed component was significantly superior to that of the cemented fixed component.
Our data suggest that modular RHCM knee megaprosthesis provides an acceptable clinical result. A diaphyseal long stem with cementless fixation was more reliable and durable than its cemented counterpart.
在存在巨大骨与软组织缺损的情况下进行全膝关节置换一直是一项挑战。旋转铰链（RH）型大假体适用于伴有巨大骨缺损的广泛软组织丢失，如原发性或转移性骨肿瘤、假体周围关节反复感染或膝关节广泛创伤。然而，报道的RH型大假体的生存率并不理想。本研究的目的是评估大假体的生存率以及影响植入物存活的因素。
2001年1月至2013年6月期间，85例患者共植入了103个RH型膝关节大假体。每个假体都是模块化定制（CM）的骨水泥固定或非骨水泥固定的全膝关节系统（联合USTAR系统）。对两组的临床结果和假体生存率进行了评估。
这种CM型膝关节大假体的总体生存率在2年时为91%，5年时为83%，10年时为68%。骨水泥固定组在2年时的累积组件生存率为87%，非骨水泥固定组为96%；5年时骨水泥固定组为75%，非骨水泥固定组为94%。失败机制包括骨水泥固定柄组5例松动和6例断裂。非骨水泥固定组件的生存率明显优于骨水泥固定组件。
我们的数据表明，模块化RHCM型膝关节大假体提供了可接受的临床结果。非骨水泥固定的骨干长柄比骨水泥固定的更可靠、耐用。
